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Humana Health Insurance / fraud and cheating

1 United States Review updated:
Contact information:

Your insurance coverage details are outlined in what is called your 'certificate of coverage'. Surely you can access this from Humana's website. No, it is not available on the web. I called Humana and was told they would not send it to me. Tiffany told my husband that she could look up our plan to reference our certificate, but it would take a couple of days.

This was one of many calls where we were told something different each time we called. I have Humana Healthcare from the city I retired from, and I moved to a rural area. I was able to find a doctor on the plan. He is not close to a lab and has permission to send his lab work to the Hospital two miles away, to be tested in their lab. It was categorized as lab work only. It was a blood test on blood drawn at the doctors office... $15 co-pay and $10.00 lab work. Oh, No!! I was charged an outpatient Hospital deductible of $100.00. By Humana's definition... an Outpatient is treated at the Hospital and confined for a period of less than 23 consecutive hours.

When I argued that I was never physically at the Hospital, and therefore did not fit the definition...I was told that 'My Blood, which is a part of me' was there...so I had to pay as an outpatient.

My husband needed a stress test and went to a Cardiac Clinic in a Larger City that was In-Network, so we figured we were safe. Wrong! One of the employees that was on the bill, was not In-Network. This place had over a hundred employees. We have Tiffany on tape saying that it is the patient's responsibility to check each and every person, at the facility, who could possibly be involved in your treatment... prior to treatment...even if there are hundreds. It doesn't say that in the certificate either. This company makes it nearly impossible for you to find out what your coverage is, and then changes the wording in the agreement to find a way to deny coverage or get a larger deductible.

My husband and I have spent countless hours dealing with this company, on more ridiculous issues than I can relate here. I do have tape and documentation, though...for every claim. We are currently in the appeal process and if The City did not have a contract with Humana, I would not use them.

I definitely do not recommend them to anyone and I feel sorry for the Seniors who think Humana's Medicare Plan will help them.

Ed
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Comments

Ga
  3rd of Apr, 2009
0 Votes

Your insurance coverage details are outlined in what is called your 'certificate of coverage'. Surely you can access this from Humana's website. No, it is not available on the web. I called Humana and was told they would not send it to me. Tiffany told my husband that she could look up our plan to reference our certificate, but it would take a couple of days.

This was one of many calls where we were told something different each time we called.I have Humana Healthcare from the city I retired from, and I moved to a rural area. I was able to find a doctor on the plan. He is not close to a lab and has permission to send his lab work to the Hospital two miles away, to be tested in their lab. It was categorized as lab work only. It was a blood test on blood drawn at the doctors office... $15 co-pay and $10.00 lab work. Oh, No!! I was charged an outpatient Hospital deductible of $100.00 By Humana's definition... an Outpatient is treated at the Hospital and confined for a period of less than 23 consecutive hours.

When I argued that I was never physically at the Hospital, and therefore did not fit the definition...I was told that 'My Blood, which is a part of me' was there...so I had to pay as an outpatient.

My husband needed a stress test and went to a Cardiac Clinic in a Larger City that was In-Network, so we figured we were safe. Wrong! One of the employees that was on the bill, was not In-Network. This place had over a hundred employees. We have Tiffany on tape saying that it is the patient's responsibility to check each and every person, at the facility, who could possibly be involved in your treatment... prior to treatment...even if there are hundreds. It doesn't say that in the certificate either. This company makes it nearly impossible for you to find out what your coverage is, and then changes the wording in the agreement to find a way to deny coverage or get a larger deductible.

My husband and I have spent countless hours dealing with this company, on more ridiculous issues than I can relate here. I do have tape and documentation, though...for every claim. We are currently in the appeal process and if The City did not have a contract with Humana, I would not use them.

I definitely do not recommend them to anyone and I feel sorry for the Seniors who think Humana's Medicare Plan will help them.

Je
  12th of May, 2009
0 Votes

Oh, man, Humana seems to remain the worst company anyone has been involved with. I, too, have kept careful records regarding Humana. I think I have over 40 phone calls--- actually, I think it is closer to 63 phone calls to Humana. I have hundreds (really, 100s) of paper claims and papers regarding Humana that I have docuemented. I am so frustrated, as it seems you are, as to how I can ask the same question to several different persons within one hour and recieve the same answer. I hope things will go better for you than what they have for me. Jenny

Qs
  30th of Jun, 2010
0 Votes

Humana is correct about the in-network thing.. that is your responsibility to verify every provider's in-network status.. they aren't going to reimburse the provider above the maximum reimbursement limits because you didn't do your homework.. it probably is in the certificate, but if not it's common sense that PPO and POS plans work that way.

Fh
  8th of Dec, 2010
0 Votes

Humana Cheats people. After paying 420 as monthly premium, Humana says the coverage does not have gynecology treatments and have 1000$ maximum benefit per year... Also they do not tell people that they don't cover pregnancy and related procedures... Cheat...cheat... Cheat

Cr
  3rd of Sep, 2014
0 Votes

Please tell me why this is an ALLOWED and ACCEPTABLE PRACTICE in the UNITED STATES OF AMERICA!!! Please what can be done NOW!!! The people of this country have become so weak and passive.

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